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담관-십이지장 문합을 시행받은 환자에서 혈액담즙증으로 발현한 담관암종
류동엽 ( Dong Yup Ryu ),정재훈 ( Jae Hoon Cheong ),이동건 ( Dong Gun Lee ),이봉은 ( Bong Eun Lee ),김동욱 ( Dong Uk Kim ),김광하 ( Gwang Ha Kim ),송근암 ( Geun Am Song ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.3
Hemobilia occurs when injury or disease causes communication between intrahepatic blood vessels and the intrahepatic or extrahepatic biliary system. The causes of hemobilia include trauma, gallstone disease, vascular malformation, inflammation, and biliary or hepatic tumors. Hemobilia could be diagnosed by endoscopy, hepatic angiography, computed tomography, and ultrasonogram. Patients with hemobilia may present with biliary colic, obstructive jaundice and gastrointestinal bleeding. Extrahepatic cholangiocarcinoma usually presents with obstructive jaundice and is one of the unusual cause of hemobilia. We, herein, report a case of hemobilia caused by cholangiocarcinoma in a 69-year-old woman. She had the past history of lung cancer and choledochoduodenostomy due to gallstone. Esophagogastroduodenoscopy revealed a blood clot protruding from the choledochoduodenostomy site and the ulcerative mass in the common bile duct. Pathologic examination of the ulcerative mass was compatible with those of cholangiocarcinoma. (Korean J Gastroenterol 2010;56:205-208)
장결핵과 크론병의 감별 진단에 있어서 체외 Interferon-γ 검사의 유용성
이정남 ( Jung Nam Lee ),류동엽 ( Dong Yup Ryu ),박성한 ( Sung Han Park ),유현석 ( Hyun Seok You ),이봉은 ( Bong Eun Lee ),김동욱 ( Dong Uk Kim ),김태오 ( Tae Oh Kim ),허정 ( Jeong Heo ),김광하 ( Gwang Ha Kim ),송근암 ( Geun Am So 대한소화기학회 2010 대한소화기학회지 Vol.55 No.6
목적: 소화기 증상과 대장 또는 회맹부 궤양을 보이는 환자에서 장결핵과 크론병을 임상 소견 및 내시경 소견만으로 구분하는 것은 어렵다. 이번 연구에서는 장결핵과 크론병의 감별을 위한 체외 interferon-γ (INF-γ) 검사의 유용성을 알아보고자 하였다. 대상 및 방법: 이번 연구는 2007년 1월부터 2009년 1월까지 장결핵과 크론병의 감별 진단이 어려웠던 60명을 대상으로 하였다. ESAT-6과 CFP-10에 반응하여 INF-γ을 생산하는 T 림프구를 측정하는 T-SPOT.TB 검사를 시행하였으며 최종 진단과 비교하여 T-SPOT.TB 검사의 유용성을 평가하였다. 결과: T-SPOT.TB 검사 결과 양성이20명, 음성이 40명이었다. 장결핵으로 확진된 12명의 환자는 T-SPOT.TB 검사가 모두 양성이었고, 기타 6명의 크론병환자와 2명의 베체트장염 환자에서 T-SPOT.TB 검사가 양성이었다. T-SPOT.TB 검사가 음성인 40명 중 크론병 38명, 베체트장염과 비특이 장염이 각각 1명이었고 장결핵은 없었다. T-SPOT.TB 검사의 장결핵 진단에 대한 민감도는 100%, 특이도는 83.3%, 양성 예측도는 60.0%, 음성 예측도는 100%였다. 결론: 장결핵과 크론병의 감별 진단이 어려운 경우에 T-SPOT.TB 검사는 음성일 경우 장결핵을 배제할 수 있는 신속한 검사로 생각한다. 향후 T-SPOT.TB 검사의 장결핵과 크론병 감별 진단에의 유용성을 확인하기 위해 대규모 전향 연구가 필요하다. Background/Aims: It is difficult to clinically and endoscopically differentiate intestinal tuberculosis (ITB) and Crohn`s disease (CD). The aim of this study was to evaluate the usefulness of in vitro interferon-gamma (INF-γ) assay for differential diagnosis between ITB and CD. Methods: Sixty patients for whom differential diagnosis between ITB and CD was difficult were enrolled between January 2007 and January 2009. The INF-γ-producing T-cell response to early secreted antigenic target 6 and culture filtrate protein 10 were measured by T-SPOT.TB blood test in vitro. We evaluated the usefulness of T-SPOT.TB blood test by comparing its results with the final diagnosis. Results: Twenty and forty patients were revealed to be positive and negative in T-SPOT.TB blood test, respectively. Of the 20 patients found to be positive, 12 patients (60%) were finally diagnosed as ITB, 6 patients as CD, and 2 patients as Behcet`s enterocolitis. Of the 40 patients with negative results, 38 patients (95%) were diagnosed as CD; one as Behcet`s enterocolitis; one as nonspecific colitis; none as ITB. The sensitivity and specificity of T-SPOT.TB blood test for ITB were 100% and 83.3%, respectively. Positive and negative predictive values of T-SPOT.TB blood test for ITB were 60.0% and 100%, respectively. Conclusions: When differential diagnosis between ITB and CD is difficult, T-SPOT.TB blood test may be a helpful and rapid diagnostic tool to exclude ITB. Prospective large-scaled studies are required for further evaluation of the usefulness of T-SPOT.TB blood test for differential diagnosis between ITB and CD. (Korean J Gastroenterol 2010;55:376- 383)
신경화 ( Kyung Hwa Shin ),김동욱 ( Dong Uk Kim ),최문기 ( Moon Gi Choi ),김원진 ( Won Jin Kim ),류동엽 ( Dong Yup Ryu ),이봉은 ( Bong Eun Lee ),김광하 ( Gwang Ha Kim ),송근암 ( Geun Am Song ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.2
A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstruct tivebowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient`s known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals. (Korean J Gastroenterol 2011;57:125-128)
이성훈 ( Seong Hun Lee ),김태오 ( Tae Oh Kim ),황상연 ( Sang Youn Hwang ),류동엽 ( Dong Yup Ryu ),이동현 ( Dong Hyun Lee ),박원일 ( Won Il Park ),김광하 ( Gwang Ha Kim ),허정 ( Jeong Heo ),강대환 ( Dae Hwan Kang ),송근암 ( Geun A 대한소화기학회 2006 대한소화기학회지 Vol.48 No.3
Rectal schwannoma is a rare mesenchymal tumor originating from Schwann`s cell. We experienced a 61-year-old female patient who complained of blood tinged and narrow calibered stool for several years, and found a 4 cm sized submucosal tumor with a central ulcer on the rectal wall during colonoscopy. She underwent transanal excision. Microscopically, the tumor was composed of fasciculating bundles of spindle cells with benign nuclear atypia and peripheral lymphoid cell cuffing. Tumor cells showed a diffuse strong immunoreactivity to S-100 protein, but not stain for CD 34, desmin and smooth muscle actin. This is the first case report of rectal schwannoma in Korea. (Korean J Gastroenterol 2006;48:195-199)
원발성 간세포암으로 오인된 위 간세포양 샘암종의 간 전이
문지윤 ( Ji Yoon Moon ),김광하 ( Gwang Ha Kim ),정재훈 ( Jae Hoon Cheong ),이봉은 ( Bong Eun Lee ),류동엽 ( Dong Yup Ryu ),송근암 ( Geun Am Song ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.4
Gastric hepatoid adenocarcinoma is a special type of gastric carcinoma, which produces AFP. We report a case of an metastatic gastric hepatoid adenocarcinoma mistaken for primary hepatocellular carcinoma (HCC). A 72 year-old woman was transferred to our hospital for treatment of the hepatic mass. She underwent subtotal gastrectomy for gastric cancer 2 years ago. A year ago, she was diagnosed with hepatic mass and treated with transhepatic chemoembolization under the suspicion of primary HCC in other hospital. The hepatic mass looked like primary HCC on CT, and serum AFP was elevated to 18,735 IU/mL. We did the transhepatic mass biopsy and compared it to the histology of the previous gastric cancer, The results of immunohistochemical staining between them was coincident, and so it was diagnosed as a hepatic metastasis of gastric hepatoid adenocarcinoma.
급성 출혈성 직장 궤양의 임상적 그리고 내시경적 특징소견과 재출혈의 위험인자
박성한 ( Sung Han Park ),김태오 ( Tae Oh Kim ),이정남 ( Jung Nam Lee ),유현석 ( Hyun Seok You ),류동엽 ( Dong Yup Ryu ),이봉은 ( Bong Yun Lee ),송근암 ( Geun Am Song ) 대한장연구학회 2009 Intestinal Research Vol.7 No.1
Background/Aims: Acute hemorrhagic rectal ulcers (AHRUs) are rare and have not been thoroughly studied. This study aimed to assess the clinical and endoscopic characteristics of AHRUs and to determine the risk factors for rebleeding after the initial management. Methods: Thirty patients who underwent colonoscopy within 48 hours of the onset of hematochezia were consecutively enrolled between January 2004 and December 2007. The patients were divided into a rebleeding group and a non-rebleeding group according to presence of recurrent bleeding after initial management. We analyzed the clinical features, including the underlying disorder, the Karnofsky performance status (PS), the use of anticoagulant or antiplatelet agents, the endoscopic findings, and the methods used for hemostasis. Results: All of the patients were elderly, in a bedridden status, and all had experienced the sudden onset of massive, fresh rectal bleeding without pain. The characteristics of the lesions on colonoscopy included solitary or multiple rectal ulcers, or Dieulafoy lesions located in the distal rectum. There were no differences between the two groups based on mean age, gender, use of anticoagulant or antiplatelet agents, PS, methods of hemostasis, and clinical outcomes. The PT (INR) and endoscopic findings (Dieulafoy types), however, differed significantly between the two groups (p=0.024 and p=0.013, respectively). Conclusions: When massive hematochezia occurs in bedridden patients with severe comorbid illnesses, AHRUs should be considered in the differential diagnosis. It is advisable to be vigilant for rebleeding in patients with prolongation of the PT (INR) and Dieulafoy-type ulcers on colonoscopy. (Intest Res 2009;7:8-13)
황종민 ( Jong Min Hwang ),김광하 ( Gwang Ha Kim ),김원진 ( Won Jin Kim ),이희선 ( Hee Sun Lee ),이혜원 ( Hye Won Lee ),류동엽 ( Dong Yup Ryu ),송근암 ( Geun Am Song ),박도윤 ( Do Yun Park ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.3
Menetrier`s disease is a rare entity characterized by large, tortuous gastric mucosal folds. The mucosal folds in Menetrier`s disease are often most prominent in the body and fundus. Histologically, massive foveolar hyperplasia (hyperplasia of surface and glandular mucous cells) is noted, which replaces most of the chief and parietal cells. Profuse mucus is usually observed during the endoscopy but there have been few cases that show interesting endoscopic findings such as mucus bridge or water pearl. Herein, we report a case of Menetrier`s disease showing mucus bridge by excessive mucus observed during the endoscopy. (Korean J Gastroenterol 2011;57:184-188)